Revised to reflect Affordable Care Act Changes

MassHealth - Affordable Care Act (ACA) Changes

• Increased income limits for 19-20 year olds- 19- and 20-year-olds with incomes up to 150 percent FPL are now considered children under MassHealth, will receive MassHealth Standard benefits, and will be exempt from co-payments. Previously, MassHealth defined children as ages zero to 18; 19 & 20 year olds were subject to the adult 133% FPL income limit. (Parents are still defined as parents living with children under age 19, and 19- and 20-year-olds with income over 150 percent FPL will not be able to qualify for Family Assistance as children.)
• Former Foster Children eligible up to age 26 - former foster care children up to age 26 are now eligible for MassHealth Standard regardless of income. Previously former foster children were only eligible up to age 21.

 

Staying on a Parent's Insurance

• Young Adults up to age 26 can stay on their parent's insurance plan
• The ACA requires that if the plan covers children, that children and young adults up to age 26 be considered eligible dependents and be allowed to stay on their parent’s insurance plan.
• Young adults can join or remain on a parent's plan even if they are married, not living with their parents, attending school, not financially dependent on their parents and/or are eligible to enroll in their own employer’s plan.
• Geographic considerations- young adults who live distant from their parents are advised to investigate the extent of coverage under their parent's plan in their area. Some plans may only offer emergent coverage outside of their geographic area, for example, or charge higher co-pays for out-of-network care.
• Previously in Massachusetts, young adults could stay on their parent’s private health insurance plan for two years after last qualifying as dependents or until their 26th birthday, whichever came first. And this provision was only applicable to fully insured health plans in Massachusetts. Complying with the ACA provision, this option is now extended to young adults until age 26 and to those whose parents are in self-insured plans.
  (Sources: http://bluecrossmafoundation.org/sites/default/files/download/publication/Reforming_Reform_PtII_FINAL.pdf and https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/)
• Also see: Young Adult's Guide To New Health Insurance Choices, NPR, 10-13.

 

Coverage through The Connector

• Purchasing subsidized plans through The Connector - For young adults who are not eligible for Medicaid, premium tax credits would be an option if they have incomes in the subsidy-eligibility range (100 percent to 400 percent of the poverty line), their parents don’t claim them as a dependent on their tax return, and they don’t have an offer of affordable* and adequate coverage from their own employer. (Source: http://www.offthechartsblog.org/health-reform-gives-young-adults-coverage-choices/ )

  • *Affordability - under federal rules, employer-based coverage is affordable if a worker's share of the monthly premium for an individual plan is not greater than 9.5% of the worker's income. The cost of a family plan, which is much higher than the cost of an individual plan, is not taken into account.

   

• Catastrophic Plans - People under 30 and people with hardship exemptions may buy a "catastrophic" health plan. This type of plan mainly protects from very high medical costs. These plans though also cover some prevention services. Catastrophic plans cover 3 primary care visits per year at no cost (before the deductible). These plans are not eligible for subsidies. (Source and more information: https://www.healthcare.gov/can-i-buy-a-catastrophic-plan/)

 

College Students' Options

• See Student health insurance and national health care reform: What does it mean for you? - Mass Health Connector (Spring 2014)
• Subsidized Programs- MA residents can apply for subsidized plans through The Connector. Under the Affordable Care Act the state is no longer allowed to exclude from subsidized programs those who can get insurance elsewhere, including college students (though working college students with access to employer sponsored health insurance would need to show it doesn't meet affordability standards before qualifying for a subsidy. See affordability above.). The Massachusetts Health Connector issued rules in December 2013 requiring colleges to accept plans from the Connector or MassHealth, with a few rare exceptions. (Learn more.)
• Parent's Health Insurance- see above.
• Student Health Insturance - Massachusetts law requires that students enrolled in a certificate, diploma or degree granting program in a Massachusetts college, university or other institution of higher learning participate have health care coverage. One option is a school-sponsored student health insurance program.
  • Eligibility: enrolled in a certificate, diploma, or degree-granting program of a Massachusetts institution of higher education, and taking 75% or more of the requirements of a full-time student.
  • Coverage: Usually offer only limited coverage ($1500) of pre-existing conditions until 6 months after coverage start date.
    • All SHP plans must include basic coverage for:
      • primary and preventive care
      • hospitalization
      • surgical services
      • ambulatory patient services
      • emergency services
      • mental health services
    • The amount of benefits you can get per sickness or injury may be limited. Other benefits may also be limited. You should read your school’s SHP policy to see the specific benefits you will get. The SHP policies are usually available online on your school’s web site.
  • Citizenship: Immigration status does not matter. All full and part-time students are eligible and must have health insurance. International students must enroll in SHP if they do not have comparable health coverage in the U.S.
  • Coverage is required. One must enroll in coverage or demonstrate comparable coverage.
  • This section adapted from Massresources.org